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General NPI Number Information
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NPI Number | 1295326494
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Entity Type | Organization
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Legal Business Name | WENTWORTH DOUGLASS PHYSICIAN CORPORATION
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Dates
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Enumeration Date | 01/30/2021
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Last Update Date | 12/17/2025
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Provider Practice Location Address
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Address Line | 7 MARSH BROOK DR STE 205
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City | SOMERSWORTH
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State | NH
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Zip | 03878-6523
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Country | US
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Telephone | 603-742-2007
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 412503
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City | BOSTON
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State | MA
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Zip | 02241-2503
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR OF FINANCE
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Name | ASHLEY DEGENAARS
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Credential |
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Telephone | 603-740-2806
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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